6 Reasons why Anesthesia practices should hire certified Anesthesiology coders
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There was a time when medical coding was a simple job. When paper trolleys trundled across hallways and technology was for upstart, young physicians who were glued to their phones. But that was the healthcare space of yesterday and it is quickly disappearing over the horizon. The industry is now in a remarkably active place of tech enabled solutions, integrations and value based business models.
Medical practices that do not roll with the changes will have to go off the grid. That is the arithmetic. But most healthcare organizations still follow antiquated ways of working. Like, working with medical coders who don’t hold specialty specific certifications. Especially, in a specialty like anesthesiology where medical coding is incredibly complicated.
Here are 6 major reasons why your medical coder needs specialty specific certification
1. To eliminate anesthesiology coding inefficiencies
Coding for anesthesiology can drive coders who are not familiar with the specialty up the wall. Every single CPT code has to be crosswalked to the correct anesthesia code based on the region of the body, age, level of sedation and technique. Calculating base units and time units accurately comes with appropriate training and education.
Only a certified anesthesiology coder can perform a through clinical review of a medical record, spot and report documentation inconsistencies, summarize the findings and ensure that the best reimbursement is received for a service.
2. Minimize coding related denials
The most common denials faced by anesthesiology practices is MAC denials. The major reason for MAC denial is the insurer’s assumption that a procedure could’ve been completed under moderate sedation and that a higher level of sedation wasn’t necessary. Of course denials are not limited to Monitored anesthesia care (MAC) cases alone but it the most common type of denial encountered.
Postoperative pain blocks that are bundled with surgery claims are also frequently denied. The best solution to solve these denials? Provider documentation. As certified coders are well-versed with the documentation required to support claims there’s a significantly lower chance of a claim being rejected. They’re also more adept at assigning codes according to the appropriate sedation level.
A trained and certified anesthesiology coder can reduce your accounts receivable by reviewing claims rejected for coding and make appropriate edits to the claim. Thereby lowering your denial rate.
3. Abstract information more accurately
Abstracting and analyzing provider information when there are hundreds of charts to be audited per day is a tough task. It takes expertise to abstract information from charts and assign accurate codes, quickly. Certified coders are trained in medical terminology, anatomy and physiology.
To gather information from pre anesthesia, post anesthesia, PACU records, and the surgeon’s operative report and translate it into medical codes is no easy task. Certified anesthesia coders can abstract the most complex of clinical data much faster than average medical coders. On an average a medical coder can code about 25-30 charts an hour. Specialty focused coders on the other hand can code over 40 charts an hour. This increases the productivity of your coding process and accelerates the coding cycle.
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4. Report qualifying circumstances meticulously
There are various qualifying circumstances that can be submitted to insurers to improve reimbursement. Additional codes result in significantly higher reimbursement for anesthesiologists and CRNAs. For an example code +99100 can be used for a patient who is older than 70. By missing out on this code and coding for the primary anesthesia procedure alone prevents medical practices from billing to their highest revenue potential.
Add on codes can be used to specify emergency situations and procedures complicated by pre-existing conditions or medical complications. Certified anesthesiology coders are trained to report qualifying circumstances accurately. This leads to improved documentation of the patient’s record and compliance with reporting standards.
5. Calculate time for anesthesia services
Time units play a major role in reimbursement. But unfortunately most anesthesiology claim rejections are due to improper calculation of time units. Novice coders usually mention the units alone. Insurers expect the time to be stated in the claim as well. Else, it takes longer to pay.
The guidelines for reporting time units vary between commercial insurance companies and Medicare. A certified anesthesiology coder is trained in these nuances and can assure physicians and facilities of proper reimbursement for the services rendered.
6. Coding for medically directed anesthesia services
Two separate claims must be filed for medically directed anesthesia procedures. Claims must be coded and filed separately for the anesthesiologist and the qualified non-physician anesthetist. Appropriate modifiers must me assigned according to the medical directions given. If the medical directions are not met a separate modifier must be used. This can be way too complicated for a medical coder who’s not trained or certified in the specialty.
Nothing’s changed except everything…
The healthcare field has changed drastically over the last few years. With the downward pressure on anesthesiology medical practices to comply with coding regulations and maintain pristine documentation, hiring certified coders is a solution that will help you face the reimbursement challenges of today.
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